Enacts provisions making changes to the vaccination requirements applicable to long term care facilities; repealer

Section 2 of the bill repeals PHL § 2190. the short title.

Section 3 of the bill amends PHL, § 2191 to remove the definition of "documentation," revise the definition of "medically contraindicated," remove the definition of "employee," and add a definition of personnel."

Section 4 of the bill amends PHL, § 2192 to remove a requirement that employees of long term care facilities be vaccinated against pneumococcal disease and replace references to "employees" with "personnel" in requiring that such individuals be immunized for influenza virus.

Section 5 of the bill amends PHL § 2193(2) to require long-term care facilities to include certain details when documenting the influenza and pneumococcal vaccinations given to residents annually. including the site of administration, the name of the person ordering the administration of the vaccine, and any reactions.

Section 6 of the bill amends PHL § 2194 to replace references to employee with "personnel," remove a requirement that long term care facilities request employees to be vaccinated against pneumococcal disease, and require that personnel receive annual vaccinations against influenza, at no cost to them.

Section 7 of the bill amends PHL § 2195 to: (1) clarify the existing exceptions to the immunization requirements of PHL § 2192; (2) remove the exception permitting personnel to refuse influenza vaccinations. other than in cases of medical contraindication or where vaccination is against the individual's religious beliefs: and (3) add an exception to the vaccination requirements for a particular year if the Commissioner of Health determines that there is not an adequate supply or a vaccine in that year.

Section 8 of the bill amends PHL § 2196(1) to clarify that the Commissioner of Health's promulgation of regulations to implement the provisions of PHL. Article 21-A is discretionary, rather than mandatory. The section further revises the current requirement that the Commissioner must take into consideration any recommendations issued by the federal Centers for Disease Control and Prevention (CDC) by specifying that it is the recommendations of the CDC's Advisory Committee on Immunization Practices (ACID) that must be considered.

Section 9 of the bill adds a new PHL. § 2196(4) to require long term care facilities to collect annual aggregate data on personnel and resident vaccination status and report such data to the Department of Health (DOH).

Section 10 of the bill provides that the bill would take effect on September 1, 2010.

Existing law

The Long Term Care Resident and Employee Immunization Act, codified as PHL Article 21-A (PHL §§ 2190 through 2196), applies to long term care facilities, specifically nursing homes, adult homes, enriched housing programs, adult day health care programs, and any other facility providing residential housing and supportive services for five or more persons over the age of 65 who are unrelated to the operator. Article 21-A requires that all residents and employees be immunized against. influenza and pneumococcal disease. However, PHL § 2195 permits refusal if the vaccine is medically contraindicated, if vaccination is against the person's religious beliefs, or if he or she refuses the vaccine after being fully informed of the health risks of such action.

PHL §§ 2193 and 2194 require long term care facilities to document the influenza and pneumococcal vaccinations given to residents and employees annually. If there is no evidence that the person had such annual vaccines, the facility must provide or arrange for them to be administered.

Legislative history

The provisions of this bill were included in A.10942, introduced in 2008. A subsequent amended version (A.10942-A) and associated versions introduced in the Senate (S.7822-A and S.8623) did not include the provisions of this bill.

Statement in support

Each year, influenza causes significant morbidity and mortality in the United States, especially among the vulnerable populations in long term care facilities. The transmission of influenza associated with health care providers contributes significantly to this burden, Recognizing the need to protect long term care facility residents, the CDC has recommended influenza vaccination for health care personnel since 1981. In February 2006. the CDC's Healthcare Infection Control Practices Advisory Committee (HICPAC) and the ACIP jointly recommended that all health care personnel be Vaccinated annually against influenza.. Despite these recommendations, and despite efforts designed to increase vaccination rates for health care personnel, the proportion of health care workers who are vaccinated annually remains unacceptably low (approximately 40 percent nationally).

PHL Article 21-A currently requires immunization of both residents and employees of long term care 'facilities, but allows individuals to refuse immunization and has not resulted in immunization at levels which are sufficient to protect residents of such facilities. Data available to DOH has consistently shown that although residents in long term care facilities are relatively well immunized, the rate of vaccination of employees against influenza remains extremely low and has not appreciably increased over the years. Accordingly, this bill imposes mandatory vaccination of personnel in long term care facilities unless vaccination is medically contraindicated or against an individual's religious beliefs.

Further, the bill substitutes the broader term personnel member' for the term "employee," consistent with the February 2006 recommendations of HICPAC and ACIP, to require vaccinations against influenza for all paid and unpaid persons working in health care settings who could potentially expose residents, or others with direct contact with residents, to influenza. DOH also anticipates changing its regulations applicable to hospitals, home care agencies, diagnostic and treatment facilities, and hospice programs to similarly require personnel in those settings to receive an annual influenza vaccination.

The pneumococcal vaccine is not recommended by HICPAC or ACIP for healthy persons less than 65 years of age, unless they have underlying health conditions warranting such vaccination. Accordingly, this bill eliminates the existing requirement that employees of long term care facilities be vaccinated against pneumococcal disease.

Finally, the bill requires long term care facilities to report annual aggregate data on personnel and resident vaccination status to DOH. While DOH already conducts an annual survey of vaccination rates at long term care facilities, placing this requirement in statute will improve compliance and emphasize the importance of accurate reporting. This will assist DOH in assuring that vaccinations occur as required, helping reduce the incidence of influenza and pneumococcal disease among vulnerable populations and avoid large-scale outbreaks.

Budget implications

The proposed changes in vaccination requirements for health care workers in long term care facilities would not have a fiscal impact on the State. Long term care facilities would bear the cost of purchasing extra doses as needed to comply with this bill (approximately 515 per dose), but many personnel are likely to obtain the shots from their primary care providers, which would be covered by their health care insurance. In addition, vaccinating all personnel against influenza will benefit facilities through reduced absenteeism.

Effective date

This bill takes effect on September 1, 2010.